Provider Demographics
NPI:1942287420
Name:CHAVEZ, KRISTEN (PT)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:CHAVEZ
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:KRSITEN
Other - Middle Name:
Other - Last Name:SNYDER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PT
Mailing Address - Street 1:23825 COMMERCE PARK
Mailing Address - Street 2:SUITE B
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5837
Mailing Address - Country:US
Mailing Address - Phone:216-292-6363
Mailing Address - Fax:216-292-6306
Practice Address - Street 1:4766 BELPAR ST NW
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-3603
Practice Address - Country:US
Practice Address - Phone:330-244-1001
Practice Address - Fax:330-244-1002
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-27
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPT11273225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist